Medicine an Surgery notes

SHOULDER DYSTOCIAPROBLEM-The fetal head has been delivered but the shoulders are stuck and cannot be delivered.GENERAL MANAGEMENT-Be prepared for shoulder dystocia at all deliveries, especially if a large baby is anticipated.-Have several persons available to help.Shoulder dystocia cannot be predicted. DIAGNOSIS-The fetal head is delivered but remains tightly applied to the vulva.-The chin retracts and depresses the perineum. -Traction on the head fails to deliver the shoulder, which is caught behind the symphysis pubis.MANAGEMENT-Make an adequate episiotomy (page P-71) to reduce soft tissue obstruction and to allow space for manipulation.-With the woman on her back, ask her to flex both thighs, bringing her knees as far up as possible towards her chest (Fig S-26, page S-84). Ask